Context: More than 1000 children are newly infected with Human immunodefi ciency virus (HIV) every day, and of these more than half will die as a result of AIDS due to lack of access to HIV treatment. HIV disease varies considerably in children. Among those infected prenatally, some experience few or no symptoms for years, whereas in others the disease progresses rapidly. The risk factors that influence the development of such oral manifestations include, low CD4+ T cell count, xerostomia and lack of highly active antiretroviral therapy (HAART). Aims: To identify the oral manifestations of HIV in children receiving HAART. Materials and Methods: The study comprised 95 children receiving HAART. 95 HIV +ve children not receiving HAART and 95 HIV -ve children were also included for comparing the manifestations of HIV. Statistical Analysis Used: Statistical analysis was done using Fisher's Chi-square test. Probability value (P value) was obtained for the three groups. Results: The manifestations of HIV that were observed in children receiving HAART include dental caries (26%), periodontal diseases (23%), candidiasis (19%), hyperpigmentation (17%), ulcerative stomatitis (9%) and one case of mucocele. These manifestations were compared with HIV +ve children not receiving HAART and HIV -ve children to find manifestations with statistical significance. Conclusions: We conclude that HAART had increased the disease-free states in HIV +ve children on HAART promising them better life span. The incidence of oral lesions can further come down with adequate oral hygiene measures in HIV-infected children.

Context: In routine histopathology, decalcification of bone and teeth is often an essential and important step during tissue processing. Various decalcifying agents have been used in the past. The rate of decalcification and the effect of decalcifying agents on the tissue and its staining characteristics are two important parameters which influence the selection of decalcifying solutions. Though some agents remove the calcium ions completely and rapidly, they adversely affect the staining characteristics and may also damage the organic components. There have been very few studies which have systematically evaluated the efficacy of these agents in decalcifying dental hard tissues. Aims: The present study was done to evaluate the rate of decalcification of six different decalcifying agents and also their effect on staining characteristics on dental hard tissues. Materials and Methods: Six decalcifying agents namely, neutral ethylene diamine tetra acetic acid (EDTA) decalcifying solution, 5% nitric acid, Perenyi's fluid, formalin-nitric acid, 5% trichloracetic acid, and 10% formic acid were used to decalcify 24 natural teeth (four in each solution). The endpoint of decalcification was evaluated by radiographic and chemical methods. The decalcified teeth were then routinely processed, sectioned, and stained with hematoxylin and eosin stains. Results: Neutral EDTA was the most considerate to the soft and hard tissues and 5% nitric acid was the least considerate to the tooth structure. Conclusions: Neutral EDTA, though being the slowest decalcifying agent among the six agents used in the study, gave excellent results for soft-tissue integrity, and best quality of both soft-tissue and hard-tissue stainings.

Toluidine blue: A review of its chemistry and clinical utilityGokul Sridharan, Akhil A ShankarMay-August 2012, 16(2):251-255DOI:10.4103/0973-029X.99081

Toluidine blue is a basic thiazine metachromatic dye with high affinity for acidic tissue components, thereby staining tissues rich in DNA and RNA. It has found wide applications both as vital staining in living tissues and as a special stain owing to its metachromatic property. Toluidine blue has been used in vivo to identify dysplasia and carcinoma of the oral cavity. Use of toluidine blue in tissue sections is done with the aim to highlight components, such as mast cells granules, mucins, and cartilage. This article provides an overview on chemistry, technique, and the various applications of toluidine blue.

Aim: The aim of this work was to determine the frequency and nature of oral manifestations in a hypertensive patient. Materials and Methods: The study sample consisted of 465 known hypertensive patients, between the age group of 20-80 years of which 250 patients were males and 215 were females. 105 were between the age group of 1-40 years, 136 in 41-50 years, 110 in 51-60 years, and 114 in 60 and above year of age. Data were statistically analyzed Student's t-test. Results: 79.14% of the patients presented with Russell's periodontal index score ranging from 2- 4.9 which suggested an established periodontal lesion. The risk factors for old men and women to develop hypertension were 90%, among those who survived to ages 65 to 89 years. Conclusion: The frequency of potential oral manifestations in patients with hypertension was significantly high, thus showing an association of gingival and periodontal pathology in hypertensive patients

Fibrous dysplasia (FD) of bone is a congenital non-heritable disorder that was first reliably reported by von Recklinghausen, when he described patients with pathologic condition of bone characterized by deformity and fibrotic changes that he termed as osteitis fibrosa generalisata. FD may involve one bone (monostotic) or multiple bones (polyostotic) and occurs throughout the skeleton with predilection for long bones, ribs, and cranio-facial bones. Seventy percent of the lesions are monostotic and asymptomatic, and identified incidentally. The polyostotic form of disease is often deforming and devastating, with multiple skeletal complications like repeated fractures, limb length discrepancies, and bone pains. The bone lesion of unknown origin is characterized by slow progressive replacement of normal bone by abnormal proliferative, isomorphic fibrous tissue. This case report documents a 40-year-old male with severe polyostotic FD that involved most of the skeleton, including long bones of all extremities, pelvis, facial bones, and skull base. Initial evaluation consisted of physical examination, plain radiographs, which was followed by computed tomography scan, Single-photon emission computed tomography scan, and biochemical and hematological examination. This paper stresses on the clinical implications and management of this rare debilitating disease.

Langerhans cells (LCs) were first described by Paul Langerhans, in 1868, as dendritically shaped cells, which were located in the squamous epithelia of epidermis. Later on, these cells were identified in all stratified squamous epithelium of mammals. Dendritic cells (DCs) play an important role in local defense mechanisms in the epithelium. LCs are situated usually in the suprabasal layer of stratified squamous epithelia of oral mucosa and epidermis of skin. They constitute 3% of the cell population in epidermis. LCs are thought to act as antigen presenting cells (APCs) during initiation of immune responses. With the help of APCs, the lymphocytes are able to recognize and respond to specific microbes. In this paper we have reviewed the origin, distribution, demonstration and mechanism of action of LCs and their role in different pathological conditions.

Teeth are specialized structural components of the craniofacial skeleton. Developmental defects occur either alone or in combination with other birth defects. Macrodontia of anterior teeth may occur as an isolated condition or as a result of fusion or gemination and can occur in the primary or permanent dentition. Fusion is more commonly seen in the anterior maxillary region. This case presentation reports a case of fusion of a supplemental tooth to one in the normal series in conjunction with a talon cusp. This condition is extremely rare and has been reported at fourth occasion in the literature. The etiology, prevalence, clinical features, and management of the aforementioned anomalies have been reviewed in detail. Early diagnosis of this condition is important because it may cause clinical problems, such as esthetic concerns and tooth crowding.

Collagenous fibroma (desmoplastic fibroblastoma) is a distinctive yet uncommon fibrous soft tissue tumor. These tumors are rather nondescript in their morphological appearance and have been diagnosed as fibromas or some other benign mesenchymal lesions for years. The most common sites are the upper extremities, followed by the lower extremities. Rare lesions arise in the head and neck region. We report a rare case in the oral cavity and present its unique histopathological features (central fat entrapment) besides others, and diffusely strong vimentin immunopositivity.

Tumors of jaw bones are among the most uncommon of all types of neoplasms. Osteosarcoma of jaw bones represents a distinct group of lesions from the conventional type commonly occurring in long bones. Nonetheless, our present knowledge of the tumor allows us to affirm that its clinical behavior and pathologic features differ markedly from those of its homolog in the long bones. The maxillary tumors show predilection for posterior portion of the alveolar process and the antrum, whereas the body is most commonly involved in the mandible followed, by angle, symphysis, and ascending ramus. We have reviewed around 300 cases of osteosarcoma of varied racial origin from PubMed indexed journals spanning from 1967 to 2010 and present their etiology, pathogenesis, features and treatment modalities.

Background: Oral submucous fibrosis (OSF) is a precancerous condition in which there is excessive deposition of collagen in connective tissue. The purpose of present study was to compare changes in birefringence of collagen fibers in histopathological stages of OSF. Materials and Methods: Collagen in connective tissue of 91 cases of OSF was studied by staining 5 μm thick sections with picrosirius red. The polarization colors of thin (0.8 μm or less) and thick (1.6-2 μm) collagen fibers were recorded. Results: The birefringence of thin collagen fibers showed no difference in both histopathological connective tissue stages and degrees of epithelial dysplasia. The polarization colors of thick collagen fibers showed a gradual change from predominantly yellow-orange to greenish-yellow in advancing connective tissue stages and degrees of epithelial dysplasia. Conclusion: The results of present study show a significant change in birefringence of collagen between connective tissue stages and between mild, moderate to severe degree of epithelial dysplasia. This change in birefringence colors and arrangement of collagen fibers may give an implication of impending neoplastic change in OSF.

Recent technological advances have made saliva as a tool for diagnosis of many things; among them are hormone imbalances, liver function, immunodeficiency and even cancer. Aim: The present study was done to evaluate the levels of copper and zinc and copper/zinc ratio in saliva of premalignant and malignant lesions of oral cavity, because of the anatomical proximity of the saliva to both premalignant and malignant oral neoplasms. Materials and Methods: The levels of copper and zinc were estimated in the saliva of 5 patients with oral submucous fibrosis, 5 patients with oral leukoplakia, 5 patients with oral lichen planus and 10 patients with oral squamous cell carcinoma of oral cavity using inductively coupled mass spectrometry (ICP- MS). The values were compared with 6 normal age and sex matched control subjects. Results: There was significant difference of the mean salivary copper and zinc levels of premalignant and malignant lesions when compared to the normal controls. In oral cancer patients there was significant difference in the copper levels according the histodifferentiaton in squamous cell carcinoma. Within the premalignant group the copper levels were more in the oral sub mucous fibrosis when compared to the leukoplakia and lichen planus. Copper zinc ratio decreased in premalignant and malignant group when compared to the normal group. Conclusions: Saliva may be used as a potential diagnostic tool, which can be efficiently employed to evaluate the copper and zinc levels in pre malignant and malignant lesions of oral cavity. Key words: Copper, inductively couples mass spectrometry, leukoplakia, lichen planus, oral squamous cell carcinoma, oral submucous fibrosis, saliva, zinc

The use of salivary cytokines as a screening tool for oral squamous cell carcinoma : A review of the literatureTarig A Osman, Daniela E Costea, Anne C JohannessenMay-August 2012, 16(2):256-261DOI:10.4103/0973-029X.99083

Oral squamous cell carcinoma (OSCC) is the most common type of head and neck cancer. The 5-year survival rate has remained below 50% over the last two decades, and new tools for early diagnosis are needed. Saliva has been used for diagnosis of several systemic diseases, and its use for diagnosis of OSCC has been sought extensively. Among the many salivary analytes for diagnosis of OSCC, accumulating evidences indicate the possibility of using salivary cytokines. Overproduction of proinflammatory, proangiogenic cytokines by OSCC cells has been reported, and their role in tumor progression and angiogenesis is well established. However, many inflammatory conditions and immunological diseases could affect the levels of cytokines in serum and saliva. This article has reviewed publications in this matter, and some strengths and weaknesses have been pointed out. Conclusively, large-scale investigations are required for validation of the use of salivary cytokines for diagnosis of OSCC, with consideration to the influential role of periodontal inflammation in their levels.

Dens invaginatus or 'dens in dente' is a developmental malformation of the tooth resulting from infolding of the dental papilla before calcification. This article presents a case of dens invaginatus occurring in maxillary right lateral incisor of a 45-year-old male patient. The patient presented with pain and clinically missing maxillary right canine. The tooth was found to be non-vital. Radiographic examination revealed the tooth-in-tooth appearance of lateral incisor with a dilated pulp chamber. The crown of impacted canine was found within the pulp chamber of lateral incisor. Owing to this unique clinical presentation, both the lateral incisor and the impacted canine were extracted. Histopathologic examination confirmed the diagnosis of Dens invaginatus Type III B. A brief review on etiopathogenesis, radiographic features and treatment of dens invaginatus has also been included.

Background: Bisphosphonate therapy is widely used for the treatment of bone metastasis in breast cancer patients. Aim: The aim of this study is to estimate the overall prevalence of bisphosphonate induced osteonecrosis of jaw (BONJ) in breast cancer patients with bone metastasis. Materials and Methods: A literature review was conducted to search and evaluate all the articles that contained original data on the prevalence of BONJ in breast cancer patients from the year 2003-2009. Pubmed search terms used were bisphosphonate, osteonecrosis, breast cancer and jaw. Eleven publications that fulfilled the inclusion criteria were chosen for the study. Case reports and reviews were excluded from the analysis based on assessing the title and abstract. Results: Of the 2490 breast cancer patients, 69 developed BONJ with the overall prevalence rate of 2.8%. All the patients with BONJ had received zoledronate or pamidronate, either alone or in combinations. Conclusion: BONJ is a significant complication occurring in 2.8% of the breast cancer patients receiving bisphosphonates for metastatic bone disease. It is very important to identify the trigger factors associated with BONJ and also to establish guidelines for the prevention and effective treatment of this condition.

Background and Aims: Recent microbiological researches have revealed the possible role of human cytomegalovirus (HCMV), Epstein barr virus (EBV), and herpes simplex virus (HSV-1 and HSV-2) in the etiopathogenesis of periodontal diseases. The present pilot study has been undertaken to detect the presence of these viruses in chronic periodontitis, aggressive periodontitis, and healthy individuals and to determine the relationship between these viruses and the clinical parameters. Materials and Methods: A total of 10 patients belonging to the age group of 18 to 55 years were included. The patients were randomly assigned into periodontally healthy (sulcus depth ≤ 3 mm), chronic periodontitis, and aggressive periodontitis with pockets measuring ≥6 mm. Seventy-five subgingival plaque samples (25 samples from each group) were collected and subjected to multiplex polymerase chain reaction for the detection of presence of HCMV, EBV, HSV-1, and HSV-2. The results were analyzed using one-way ANOVA for multiple group comparisons followed by Student's t-test for pair-wise comparisons. Categorical data was analyzed by Fisher's exact test. Results: HSV-1 was detected in 76% (P<0.001) of sites with chronic periodontitis and 80% (P<0.001) sites with aggressive periodontitis. EBV was detected in 32% (P<0.05) of sites with chronic periodontitis and aggressive periodontitis. The probing pocket depth and clinical attachment level was statistically significant in HSV-1 detected sites compared with undetected sites in aggressive periodontitis patients . Conclusion: Among these viruses HSV-1 and EBV were found to be significantly associated with destructive periodontal disease, including chronic and aggressive periodontitis. Further, HSV-1 was found to be associated with severity and progression of destructive periodontal disease.

Aspergillosis is a common opportunistic fungal infection affecting the nose and paranasal sinuses. The disease presents in various forms ranging from non-invasive to invasive, destructive and allergic types. We report here a rare case of invasive aspergillosis in an immunocompetent host with the literature review.

Laugier-Hunziker syndrome is a rare acquired disorder characterized by diffuse hyperpigmentation of the oral mucosa and longitudinal melanonychia in adults. They appear as macular lesions less than 5 mm in diameter. Laugier-Hunziker syndrome is considered to be a benign disease with no systemic manifestation or malignant potential. Therefore, it is important to rule out other mucocutaneous pigmentary disorders that do require medical management. Prompt clinical recognition also averts the need for excessive and invasive procedures and treatments. In India, the reported cases of this syndrome are very few. We provide a review of literature on Laugier-Hunziker syndrome with its differential diagnosis.

Aim: Though many studies have examined cysts of the jaws, most of them focused on a group of cysts and only few have examined cysts based on a particular classification. The aim of this study is to review cysts of the oro-facial region seen at a tertiary health centre in Ibadan and to categorize these cases based on Lucas, Killey and Kay and WHO classifications. Materials and Methods: All histologically diagnosed oro-facial cysts were retrieved from the oral pathology archives. Information concerning cyst type, topography, age at time of diagnosis and gender of patients was gathered. Data obtained was analyzed with the SPSS 18.0.1 version software. Results: A total of 92 histologically diagnosed oro-facial cysts comprising 60 (65.2%) males and 32 (34.8%) females were seen. The age range was 4 to 73 years with a mean age of 27.99 ± 15.26 years. The peak incidence was in the third decade. The mandible/ maxilla ratio was 1.5:1. Apical periodontal was the most common type of cyst accounting for 50% (n = 46) of total cysts observed. Using the WHO classification, cysts of the soft tissues of head, face and neck were overwhelmingly more common in males than females with a ratio of 14:3, while non-epithelial cysts occurred at a 3:1 male/female ratio. Conclusion: This study showed similar findings in regard to type, site and age incidence of oro-facial cysts compared to previous studies and also showed that the WHO classification protocol was the most comprehensive classification method for oro-facial cysts.

Ameloblastomas seldom cause diagnostic difficulties due to classic histopathological presentations. Adenoid ameloblastoma is a rare variant in this category which can cause problem in diagnosis due to the presence of areas resembling adenomatoid odontogenic tumor (AOT) and occurrence of varying degrees of dentinoid formation. In this article, we report a case of adenoid ameloblastoma with dentinoid, which was diagnosed accurately after the third recurrence. To the best of our knowledge, so far, only 13 cases have been reported of tumors that histologically show features of amelobalstoma and AOT with hard tissue formation. The recurrences were due to under diagnosis of the lesion followed by a conservative treatment.

The cleft anomaly may be more ancient than the man himself. It is one of the most common developmental malformations reported in the literature. There are number of intriguing theories regarding its etiopathogenesis, each of which has some evidence in its favor. This review highlights all the genetic and environmental etiologic factors and focuses on its pathogenesis.

Aim: To assess p53 and Cyclin D1 expression using Immunohistochemistry in normal mucosa and oral squamous cell carcinoma. Materials and Methods: Twenty cases of Oral squamous cell carcinoma (OSCC) and 10 normal mucosa were used and the primary antibodies used were p53 (DAKO-DO7) and Cyclin D1 Mouse Anti human Cyclin D1 (DCS-6) 1: 100 dilution. Statistical analysis: Labelling index was calculated and mean LI and SD were calculated, using Descriptive Statistics and t-test was used to compare mean LI between antibodies used in OSCC. Percentage positivity was done by Chi-Square test. Comparison of LI between p53 and Cyclin D1 was studied using t test. Results: p53 was positive in 30% and Cyclin D1 in40% of normal cases and 65% and 95% of OSCC were positive for p53 and Cyclin D1 respectively. Mean LI of p53 and Cyclin D1 were found to be statistically significant between the normal mucosa and OSCC. The correlation of mean LI of p53 and Cyclin D1 in OSCC was found to be statistically significant. LI of p53 was found to be higher than Cyclin D1 in OSCC. Conclusion: In the present study, increased p53 and Cyclin D1 expression were seen in OSCC when compared to the normal mucosa and a positive correlation was seen between increased p53 and Cyclin D1 expression in OSCC.

Aim: The aim of the study was to assess the expression of epithelial growth factor receptor (EGFR) in normal oral mucosa and varying grades of oral epithelial dysplasia (OED) and to correlate these findings, with clinicopathologic features and findings on routine hematoxylin and eosin-stained (H and E) sections. Materials and Methods: Twenty-nine formalin-fixed, paraffin-embedded blocks of various grades of OED and 10 normal mucosa were stained with routine H and E and immunostained with EGFR by avidin-biotin method. Results: The results showed a significant increase in the staining reactions in varying grades of dysplasia as compared with normal mucosa. Conclusion: EGFR can be considered as an early marker of a cell proliferation and maturation as well as early marker of epithelial dysplasia and onset of cancer in oral dysplasia. However, further studies with a larger sample size and continuous followup is suggested to determine its role and significance precisely.

Background: Oral lichen planus (OLP), a well-known mucocutaneous lesion has been the center of debate regarding its obscure etiopathogenesis. Recent highlight has been placed on the role of autoimmunity and a sect of constitutional molecules, the native chaperones HSP70, proposed to be important in the onset and progress of disease. Aim: To substantiate a potential role of HSP70 in the pathogenesis of oral lichen planus. Settings and Design: The study involved immunohistochemical (IHC) analyses in a laboratory under monitored conditions. It was a retrospective study on clinically and histopathologically confirmed specimens. Materials and Methods: 30 samples of confirmed cases of OLP were selected and grouped on the basis of the thickness of the epithelial layer into atrophic, normal (classical) and acanthotic. An immunohistochemical analysis of the expression of HSP70 protein was done, followed by a quantitative and qualitative analysis of the stained layers. Statistical Analyses: A Z test was performed to estimate the difference observed between two sample proportions. The statistics was given at 1% level of significance i.e. P<0.01. Results: An increased expression of HSP70 was noted in the basal and suprabasal cells of the epithelium of OLP. A higher count and intensity of HSP70 expression was seen in the basal layer of the epithelium. Greater expression was noted in the epithelium of the atrophic group. Conclusion: The expression pattern of HSP70 positively implicates it in the pathogenesis of OLP.

Pseudovascular adenoid squamous cell carcinoma (PASCC) is an uncommon histological variant of squamous cell carcinoma that can mimic vascular neoplasms, particularly angiosarcoma, in its morphologic characteristics. PASCC has been reported in the head and neck, as well as in the other organs such as the breast, lungs, urinary bladder, vulva, and uterine cervix. Only two cases of PASCC arising from the upper aerodigestive tract have been reported so far. We report a case of PASCC of oral cavity in a 40-year-old man, which mimicked an angiosarcoma initially. Immunohistochemical analysis led to a conclusive diagnosis of PASCC.

Lipoma is a common soft-tissue tumor. There are only very few reported cases of intraosseous lipoma of the jaws in the literature. Intraosseous angiolipomas are even rarer. The exact nature of these lesions is debatable, but it is widely accepted that they represent true benign tumors. These are slow-growing tumor consisting of a mass of mature fat cells. When the vascular component within these tumors is a prominent feature, they are considered to be angiolipomas. The cause of these lesions is uncertain. Clinically, intraosseous lipoma may be asymptomatic, may cause swelling, or may show neurologic signs such as hypesthesia or paresthesia, as was manifested in this case. Radiographically, the lesion usually appears as a well-circumscribed radiolucency. The diagnosis of intraosseous lipoma of the mandible may be a challenge, due to its rarity and clinical similarity with many other radiolucent jaw lesions; therefore, the histopathological examination is always required. Here, we report a case of intraosseous angiolipoma of mandible in a 21-year-old female patient.

Schwannomas (neurilemmomas) are slow-growing, benign neoplasms derived from schwann cells, the sheath cells that cover myelinated nerve fibers. These tumors most commonly arise in the soft tissues of the head and neck, as well as on the flexor surfaces of the upper and lower extremities. Intraoral lesions are uncommon, however, and intraosseous schwannomas are even rarer. In the Mayo Clinic series of 11,087 primary bone tumors, 14 cases of intraosseous schwannoma were identified, accounting for less than 1% of these benign primary bone tumors. The most common site of occurrence is the mandible, a characteristic traditionally attributed to the long intraosseous path of the inferior alveolar nerve. In this article, we describe an additional case occurring in the mandible of a 15-year-old boy.

The inverted papilloma is a unilateral sinonasal benign tumor which is characterized by aggressive local invasion, high recurrence rate, and transformation into malignancy. The etiology of inverted papilloma is still unknown. Possible causes include allergy, chronic sinusitis, occupational exposure to dusts and aerosols, tobacco, and viral infections. Treatment is complete surgical excision and close postoperative follow-up is necessary. Here we report a case of inverted papilloma arising from the hard palate with malignant transformation in a 41-year-old female. Clinical and histological features and treatment are discussed with the review of literature.

Osteochondrolipoma is a rare benign soft tissue neoplasm. It is occasionally considered to be a variant of adipose tissue neoplasm 'lipoma' showing multiple differentiation pathways of pluripotent stem cells. As with the lipomas they can be seen at any location and show cartilagenous and osteoid differentiation when located parosteally. We present a case of osteochondrolipoma located at the symphysis of the mandible. To our knowledge, this is the first reported case of an oral osteochondrolipoma associated with parosteal localization.